Provider Demographics
NPI:1861860397
Name:SPECIAL NEEDS SERVICES
Entity Type:Organization
Organization Name:SPECIAL NEEDS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLMS
Authorized Official - Prefix:
Authorized Official - First Name:SOAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-658-7117
Mailing Address - Street 1:PO BOX 6041
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-6041
Mailing Address - Country:US
Mailing Address - Phone:787-658-7117
Mailing Address - Fax:
Practice Address - Street 1:CARR 107 # KM 2/8
Practice Address - Street 2:WEST PROFESSIONAL BUILDING SUITE H
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-658-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR328161251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management